24 yr old Son has fainting and abnormal heart rhythm

[coryoliver]

My 24 yr old son has had several episodes of fainting in the past couple of months. He has had several test run, including a tilt table test, echocardiogram and halter monitor. The halter monitor showed at night while he was sleeping, that his heart rate increased to 145 while his blood pressure dropped very low. It also showed that instead of being at rest one of the ventricals would quiver instead of stopping between beats. Is this a serious issue? He was scheduled for a nuclear stress test, but his insurance refused to pay, he had a regular stress test. Other tests show the heart muscle to be strong and healthy. Should he insist on the nuclear stress test? Any answers or suggestions will be greatly appreciated.

[Jerry_NJ]

It is clear to me further testing is needed.  Given he has an insurance problem, be sure it isn't just a "coding" problem from the doctor..e.g., coded as preventive physical examination rather than corrective action for an existing problem.  That said, the Nuclear stress test isn't the most effective, albeit almost non-intrusive if one doesn't count the ingestion of nuclear materials, and the Cardio Catheterization is much more revealing, and my be covered by insurance, again if done to treat a condition.  Echocardiograms is another test you may want to check on insurance coverage for.

I have had all the above procedures and while I have failed the Nuclear stress test a couple of times over the years, when followed up with a look by catheter I was found to have no blockage in my heart (the main purpose of the Nuclear stress test is to identify poor blood circulation in/to the heart muscles.  

Sorry to read about having insurance only to find it doesn't pay. do check to see if a different medical reason will put it into the covered category.

[twinbee]

Was your son on a 24hr monitor or a 30 day event monitor? The reason I ask is that what you described is similar to what happened to me. I had a-fb and a-flutter for 4 years that was being controlled by several different meds (whenever one med stopped working I was put on another), but in April of last year I started to just pass out. I never knew when it was going to happen next. When I spoke to my EP she was alarmed and thought I was starting to have problems with "long QT". I was put on a 24hr and 48hr monitors that showed nothing. She then decided to put me on a 30 day event monitor and while I was on this monitor I had passed out and that was when I was diagnoised with having runs of V-tach. Whenever I went into V-tach I would pass out. I'm not saying that this is your sons problem, but if he was put only on a 24hr monitor, maybe you could suggest a 30day event monitor to try to find out what is going on.

[coryoliver]

He had the echocardiogram and was only on a 24 hr monitor. The doctor states it is Vtach episodes.
After a regular stress test this morning, the cardiologist called this evening and is referring him to a specialist who deals with the electrical functioning of the heart. His PC has mentioned Ablation. Is this what the new referral could be for? He just stated he is making the referral and my son did not ask any questions.

[twinbee]

Your sons PC is probably referring him to an Electrophysiologist or EP. If indeed he has v-tach or any other heart rhythm problem that is the type of doctor he needs to see. I had an ablation done in January.

[lifeisajourney]

Electrophysiologist also called EP is the way to go.  The heart has pathways that send signals and sometimes a pathway or pathways in a sense just keep spinning, not sending the signal the way they should.  The EP is trained for a procedure called radio frequency ablation (out patient), where they map out the pathways, take the heart rate up, and get the heart to in a sense overload as it has done for your son.  They then cautherize that area, put you at rest for 15-20 minutes and then take the heart rate up again, to be sure it has stopped.   It depends how many pathways need attention and they don't know until they get in there. It is done through the groin through the veins.  I had two pathways done 6 weeks ago.  The man before me was in there it seemed like forever.  He had more pathways and it took more time for his  procedure.  I go back to the cardiologist on Monday.  Write if I can share anything else I have been learning.  Your son is young and at his age a good strong system for such a procedure if that is what is recommended.  Be sure to share  with the EP about the fainting.  

[RickDG]

When I read your first post I immediately thought VTac - high pulse rate and low blood pressure are some of the signs.  Forget about your PC at this point, the EP is the doc you need.  Get a good one, they aren't all created equal.  If it's an electrical problem and not a plumbing problem (valve leak, ect), then the EP will recommend an ablation.  they are highly effective (even though I have had three and it didn't fix me).  If he's fainting, then you should take him to an ER the minute he goes into VTac.  This way, if he's admitted they'll do the ablation to treat the problem instead of as a potentially elective.  Depending on the hospital you take him to, they may send him by ambulance to a hospital with an EP lab and hold him a coupla days until they do the ablation.  That's what happened to me on two of my three ablations.  Be sure you tell the ER docs he has a history of VTac, they aren't very good at catching it. They always seem to think it's SVT on younger people.